Posttraumatic acute arterial subdural hematoma manifested during anesthesia

Traumatic acute arterial subdural hematomas are rare and are associated with a high mortality rate. The authors report a case in which the initial computed tomographic (CT) scan examination failed to reveal a hematoma. Within the subsequent 4 hours, while recovering from anesthesia given so that hemostasis of bleeding soft tissue injuries could be obtained, the patient suddenly developed bilaterally dilated pupils, both nonreactive to light. A repeat CT scan then revealed large subdural and intracerebral hematomas. The case is discussed and the pertinent literature is reviewed.